We attended a selected patient population of predominantly in-patients, with a high rate of TB and HIV co-infection and advanced disease which may be due to late presentation to and late referral from a health centre, factors well known to worsen TB treatment outcome [35] [38].
A significant proportion of the variation across jurisdictions and centres was explained by health centre factors within the model (37%).
We categorized the challenges identified, including health centre factors, cultural and systemic issues, and wider system factors.
The PCV in Model B (Table 7) shows that the addition of health centre factors explained 37% of the variation across jurisdictions and health centres.
Health centre factors explained 37% of the differences in level of service delivery between jurisdictions with patient factors explaining only a further 1%.
Primary healthcare centre factors, as well as individual phlebotomist factors, could be barriers contributing to poor levels of guideline practice adherence.
To determine screenee and centre factors associated with detection, multilevel (random effects) binary logistic regression was performed, with a matched polyp or cancer as the outcome variable.
Health centre factors that were independently associated with adherence to best practice guidelines included longer participation in the CQI program, remoteness of health centres, and regularity of client attendance.
For instance, EBNA3B and EBNA3C appear to be essential for the repression of the key germinal centre transcription factor BCL6, of its co-repressor and interaction partner BACH2 [61], and of NFATC2 in EBV-infected BL31 cells, with mutants showing over 10-fold increxpressionprexpression
However, as actually administered therapy depends on various factors (e.g. patients' comorbidities, development of toxicities) and may change over time due to emerging evidence, the administered systemic therapy is documented carefully for each patient in both study arms and is considered as a covariate in multivariate analysis (in addition to centre as factor in multivariate analysis).
